{"id":34608,"date":"2022-05-26T09:41:57","date_gmt":"2022-05-26T09:41:57","guid":{"rendered":"https:\/\/www.msdconnect.be\/fr\/?p=34608"},"modified":"2025-01-08T13:47:50","modified_gmt":"2025-01-08T13:47:50","slug":"lordre-prepare-un-nouvel-avis-sur-la-telemedecine","status":"publish","type":"post","link":"https:\/\/www.msdconnect.be\/fr\/2022\/05\/26\/lordre-prepare-un-nouvel-avis-sur-la-telemedecine\/","title":{"rendered":"L\u2019Ordre des m\u00e9decins pr\u00e9pare un nouvel avis sur la t\u00e9l\u00e9m\u00e9decine"},"content":{"rendered":"\n
\"\"<\/figure>\n\n\n\n

Le ph\u00e9nom\u00e8ne de la t\u00e9l\u00e9m\u00e9decine a pris de l\u2019envergure depuis le dernier avis que l\u2019Ordre des m\u00e9decins a formul\u00e9 \u00e0 ce sujet\u2026 Et un nouveau texte est actuellement en pr\u00e9paration, annonce le Pr Michel Deneyer, vice-pr\u00e9sident du Conseil National. Il insiste au passage sur les responsabilit\u00e9s du l\u00e9gislateur et plaide avec ferveur pour une m\u00e9decine de qualit\u00e9, m\u00eame lorsqu\u2019elle est exerc\u00e9e \u00e0 distance. C\u2019est ce qui explique pourquoi le futur nouvel avis op\u00e9rera une distinction entre pathologies aigu\u00ebs et chroniques.<\/strong><\/strong><\/strong><\/strong><\/p>\n\n\n\n

Apr\u00e8s avoir retrac\u00e9 l\u2019\u00e9volution que la t\u00e9l\u00e9m\u00e9decine a connue ces derni\u00e8res d\u00e9cennies sur le terrain au sein de la soci\u00e9t\u00e9 et dans le chef des m\u00e9decins, avec un positionnement prudent du c\u00f4t\u00e9 de l\u2019Ordre, le Pr Deneyer a rappel\u00e9 que c\u2019est en 2019, \u00e0 la veille de la pand\u00e9mie, que le ph\u00e9nom\u00e8ne a vraiment commenc\u00e9 \u00e0 s\u2019acc\u00e9l\u00e9rer. Il va toutefois sans dire que les circonstances in\u00e9dites li\u00e9es au coronavirus ont aussi rendu n\u00e9cessaires des mesures exceptionnelles.<\/p>\n\n\n\n

Un premier coup d\u2019acc\u00e9l\u00e9rateur est intervenu lorsque les radiologues ont commenc\u00e9 \u00e0 travailler 24\/7 en raison de la globalisation et de la d\u00e9localisation de certaines activit\u00e9s en Inde \u2013 un mode de travail \u00e0 distance qui posait un certain nombre de questions sur le plan d\u00e9ontologique et juridique. Qui y avait-il de l\u2019autre c\u00f4t\u00e9 de l\u2019\u00e9cran? De quelle formation cette personne avait-elle b\u00e9n\u00e9fici\u00e9? Quelles garanties pouvait-elle offrir en termes de continuit\u00e9 des soins et de respect du secret professionnel? L\u2019Ordre a \u00e9galement re\u00e7u un certain nombre d\u2019images relatives aux plaintes d\u2019une maman concernant de pr\u00e9tendues maltraitances infantiles. Il s\u2019est finalement av\u00e9r\u00e9 qu\u2019il s\u2019agissait d\u2019un cas de syndrome de M\u00fcnchhausen par procuration. De quoi mettre en lumi\u00e8re les dangers potentiels lorsque le m\u00e9decin ne conna\u00eet pas le patient ou n\u2019entretient pas avec lui une relation de confiance\u2026<\/p>\n\n\n\n

Conditions<\/strong><\/p>\n\n\n\n

Conclusion: la t\u00e9l\u00e9m\u00e9decine est un outil de travail qui peut \u00eatre utilis\u00e9 en compl\u00e9ment, mais les contacts en face-\u00e0-face restent l\u2019option de premier choix, en particulier dans un pays comme le n\u00f4tre o\u00f9 l\u2019accessibilit\u00e9 est excellente. Prof Deneyer:  \u00abLe cas \u00e9ch\u00e9ant, on commencera par interroger le patient sur la raison de son appel. Le m\u00e9decin veillera ensuite \u00e0 ce que trois exigences soient satisfaites \u2013 la connaissance du patient, la continuit\u00e9 des soins (qui suppose l\u2019acc\u00e8s \u00e0 ses donn\u00e9es m\u00e9dicales) et un recours \u00e0 la t\u00e9l\u00e9m\u00e9decine id\u00e9alement limit\u00e9 aux maladies chroniques \u2013 et \u00e0 ce que tout se d\u00e9roule dans le respect de protocoles scientifiquement valid\u00e9s.\u00bb<\/em><\/p>\n\n\n\n

Acc\u00e9l\u00e9ration<\/strong><\/strong><\/p>\n\n\n\n

\u00c7a, c\u2019\u00e9tait la situation \u00e0 la veille de la pand\u00e9mie, la t\u00e9l\u00e9m\u00e9decine \u00e9tant tol\u00e9r\u00e9e \u00e0 titre relativement exceptionnel dans l\u2019int\u00e9r\u00eat de la sant\u00e9 publique. Avec le Covid, chose jusque-l\u00e0 presque impensable (mais il se passe parfois des choses \u00e9tranges en temps de guerre, dixit le vice-pr\u00e9sident), des plateformes utiles et valid\u00e9es sont mises sur pied par l\u2019interm\u00e9diaire de Frank Robben.<\/p>\n\n\n\n

Une \u00e9tude de fin de master r\u00e9alis\u00e9e aupr\u00e8s des m\u00e9decins en formation \u2013 qui n\u2019a recueilli qu\u2019une centaine de r\u00e9ponses sur 500 et livre donc plut\u00f4t des tendances que des statistiques robustes \u2013 r\u00e9v\u00e8le que la connaissance du remboursement est \u00e0 peu pr\u00e8s inexistante dans ce public, ce qui est \u00e9videmment logique en l\u2019absence de toute base l\u00e9gale. Les sp\u00e9cialistes en formation semblent toutefois aussi fort mal familiaris\u00e9s avec cette mati\u00e8re sur le plan \u00e9thique.<\/p>\n\n\n\n

L\u2019apr\u00e8s-Covid met clairement au jour des r\u00e9sultats extr\u00eamement positifs pour la t\u00e9l\u00e9m\u00e9decine, par exemple chez les diab\u00e9tiques, les transplant\u00e9s ou les patients Covid n\u00e9cessitant un suivi. Les soins de plaies aussi repr\u00e9sentent un cr\u00e9neau int\u00e9ressant, puisqu\u2019on \u00e9vite ainsi de devoir d\u00e9placer en ambulance les personnes souffrant d\u2019escarres; on peut \u00e9galement citer le projet lanc\u00e9 dans le domaine de la t\u00e9l\u00e9dermatologie<\/a>.<\/p>\n\n\n\n

L\u2019app\u00e2t du gain<\/strong><\/p>\n\n\n\n

Le Pr Deneyer s\u2019inqui\u00e8te toutefois d\u2019une possible exploitation des donn\u00e9es motiv\u00e9es par l\u2019app\u00e2t du gain \u2013 une allusion \u00e0 peine masqu\u00e9e \u00e0 une mutuelle bien connue qui veut soudain rendre accessibles l\u2019ensemble de ses donn\u00e9es. L\u2019Ordre ne d\u00e9mord toutefois pas des conditions fix\u00e9es pr\u00e9c\u00e9demment et insiste, en particulier dans un contexte commercial, sur l\u2019importance de l\u2019ind\u00e9pendance professionnelle, de l\u2019absence de conflits d\u2019int\u00e9r\u00eats, du respect du secret professionnel et de la confidentialit\u00e9 ou encore de la collaboration avec la premi\u00e8re ligne.<\/p>\n\n\n\n

Le vice-pr\u00e9sident de l\u2019Ordre \u00e9gratigne au passage les dispositions actuelles d\u00e9cid\u00e9es par les autorit\u00e9s et notamment la r\u00e8gle des quatre consultations rembours\u00e9es<\/a> et l\u2019absence de distinction entre les cas aigus et chroniques. Une approche qui n\u2019est, pour lui, tout simplement pas s\u00e9rieuse.<\/p>\n\n\n\n

L\u2019Ordre entend donc r\u00e9diger un avis op\u00e9rant une distinction fondamentale entre les cas aigus, o\u00f9 le m\u00e9decin ne conna\u00eet pas forc\u00e9ment le patient, et les situations chroniques o\u00f9 la relation soignant-soign\u00e9e est clairement \u00e9tablie. Dans les pathologies aigu\u00ebs, un domaine o\u00f9 la t\u00e9l\u00e9m\u00e9decine devrait sans doute \u00eatre un peu frein\u00e9e dans son \u00e9lan selon l’Ordre, il importe de bien faire comprendre au patient que facilit\u00e9 n\u2019est pas forc\u00e9ment synonyme de garantie de qualit\u00e9. Il serait urgent que les patients partout en Belgique soient mieux familiaris\u00e9s avec le principe du m\u00e9decin titulaire du DMG (Dossier M\u00e9dical Global), estime encore le Pr Deneyer. \u00abCela permet d\u2019avoir une personne qui conna\u00eet les ant\u00e9c\u00e9dents, et ce n\u2019est en rien un plaidoyer contre la m\u00e9decine lib\u00e9rale. \u00c7a, c\u2019est la base. La t\u00e9l\u00e9m\u00e9decine n\u2019est pas l\u00e0 pour satisfaire les exigences de notre culture du tout, tout de suite.\u00bb<\/em><\/p>\n\n\n\n

Un bref contact \u00e0 distance ne peut pas \u00eatre un alibi pour justifier d\u2019une relation th\u00e9rapeutique<\/strong><\/p>\n\n\n\n

Le vice-pr\u00e9sident de l\u2019Ordre s\u2019interroge aussi sur l\u2019exigence d\u2019une attestation d\u00e8s le premier jour d\u2019absence \u2013 une disposition qu\u2019il \u00e9tait d\u2019ailleurs pr\u00e9vu de supprimer mais qui existe toujours et qui fait peser une pression consid\u00e9rable sur les m\u00e9decins de famille. Il souligne encore qu\u2019il faut trouver une solution structurelle \u00e0 la \u00ab(pseudo-)p\u00e9nurie\u00bb. \u00abUn contact \u00e0 distance de quelques minutes ne peut pas \u00eatre un argument pour justifier d\u2019une relation th\u00e9rapeutique ad aeternam\u00bb<\/em>, a-t-il averti. Cette information ne devrait pas non plus pouvoir \u00eatre enregistr\u00e9e, par exemple chez les compagnies d\u2019assurance ou m\u00eame chez les m\u00e9decins eux-m\u00eames, au risque que les donn\u00e9es ne se retrouvent \u00e0 la port\u00e9e de tous.<\/p>\n\n\n\n

Enfin, il juge la Loi Qualit\u00e9<\/a> trop stricte l\u00e0 o\u00f9 elle autorise le patient \u00e0 s\u2019opposer \u00e0 ce qu\u2019un rapport soit envoy\u00e9 lors de sa sortie d\u2019h\u00f4pital au g\u00e9n\u00e9raliste qui l\u2019y a r\u00e9f\u00e9r\u00e9. Ce rapport doit \u00eatre fourni au m\u00e9decin de famille, ne f\u00fbt-ce que par politesse. Il faut promouvoir une m\u00e9decine de qualit\u00e9\u2026 et la t\u00e9l\u00e9m\u00e9decine peut en faire partie, pour autant qu\u2019elle soit soigneusement encadr\u00e9e par la loi.<\/p>\n\n\n\n

<\/div>\n\n\n\n

Ce num\u00e9ro a \u00e9t\u00e9 r\u00e9alis\u00e9 gr\u00e2ce au support de MSD. Son contenu refl\u00e8te l\u2019opinion des auteurs mais pas n\u00e9cessairement celle de MSD. <\/strong><\/p>\n\n\n\n



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